7 Times Your Diarrhea Is Something to Worry About

You feel that telltale, urgent impulse in your stomach that tells you to get to the bathroom quick. It’s diarrhea, and you know you’re in for a long day. But did you eat something that disagreed with you, or is that loose, watery stool a sign of something more serious? We talked to gastroenterologist Theresa DiSandro, DO, of Our Lady of Lourdes Medical Center in Camden, New Jersey, to find out when to see a healthcare provider for your diarrhea.

Diarrhea is defined as at least three watery, loose bowel movements in one day. It signals a problem with either the small intestine—which will secrete too much fluid—or the colon, which will fail to absorb enough. It is most often caused by an infection that is not identified because it usually clears up on its own in 24 to 72 hours, says Dr. DiSandro. Medications such as antibiotics or the diabetes treatment metformin can also cause diarrhea, she says. But if it’s not caused by medication and it doesn’t clear up quickly, it’s time to talk to a healthcare provider. Here’s what might be causing it, and what else to look out for.

Inflammatory bowel disease (IBD) is actually two conditions: ulcerative colitis, which affects the rectum and colon, and Crohn’s disease, which can appear anywhere in the gastrointestinal tract. They are autoimmune disorders, meaning the body’s immune system mistakenly attacks healthy cells. In addition to diarrhea, other signs of IBD include rectal pain or bleeding, blood in the stool, abdominal cramping, a feeling of urgency, weight loss and fatigue. “An inflammatory condition like Crohn’s or colitis can worsen, requiring the patient to be hospitalized,” says DiSandro. There’s no cure for IBD, but symptoms can be managed through dietary changes, exercise, stress management, medications such as corticosteroids, and sometimes surgery—especially if you have Crohn’s. 

Irritable bowel syndrome (IBS) is not to be confused with IBD. Whereas Crohn’s and colitis are autoimmune diseases, researchers aren’t sure what causes IBS. Its symptoms include going number two more—or less—frequently, pain that goes away after a bowel movement, bloating and white mucus in the stool. People with IBS can have diarrhea, constipation or both. Diagnosing IBS is particularly tricky; healthcare providers typically try to rule out other conditions first. IBS is usually treated by medication and diet. Stress and anxiety can make IBS symptoms worse, so mental health treatment is often recommended. Probiotics may help some as well.

Going gluten-free is all the rage, but most people can enjoy their grains without fear. The exception is people with celiac disease. Celiac disease is a condition that’s caused by an immune reaction, triggered by gluten, a protein found in wheat, rye and barley. It causes the immune system to attack the small intestine. Chronic diarrhea is a common symptom. Also look for bloating, abdominal pain, gas, constipation and fatty floating stools. Because celiac disease damages the small intestines, people who have it may not be able to absorb nutrients as well as they need to, which can result in malnutrition. 

“If diarrhea is persistent, we worry it might be a presentation of colon polyps or colon cancer,” says DiSandro. Colon polyps are masses growing on the intestine walls that can either be benign or cancerous. Certain types of polyps excrete water and salts, which can cause diarrhea and low levels of potassium in the blood. A colonoscopy is usually performed to find polyps. If any are found, healthcare providers remove the polyps and take a biopsy to determine if they’re cancerous. 

Clostridium difficile (C. diff) is a bacterium. For many people it’s a normal and unnoticeable resident of their intestines, but prolonged use of antibiotics can cause an overgrowth. A C. diff infection is particularly hard to get rid of. “It’s a persistent disease that often doesn’t get cleared and can be aggressive in the elderly and people with weak immune systems,” says DiSandro. To make a diagnosis, gastroenterologists and lab technicians look for signs of C. diff in a stool sample. Your healthcare provider may prescribe antibiotics that are proven to kill C. diff, such as vancomycin or metronidazole. Severe C. diff infections can cause bowel swelling and holes in the bowels, both of which are likely to require surgery. 

Dehydration isn’t a cause of diarrhea, but rather can be caused by it, especially if the diarrhea is severe or lasts longer than a few days (chronic diarrhea). Your body loses more fluid and minerals—sodium, potassium, magnesium, chloride and bicarbonate—with diarrhea than it does with normal stools. If you’re dehydrated you may feel weak or dizzy, and severe dehydration can cause abnormal heart rhythms. Make sure to drink plenty of fluid for mild dehydration. If you’re irritable, sleepy, not urinating enough (or if your urine is a very dark yellow) have dry and shriveled skin, are breathing rapidly or have a rapid heartbeat, you may be extremely dehydrated and should head to the hospital for an IV solution with electrolytes. 

For cases of diarrhea lasting less than four days, it’s usually not necessary to find out what’s causing it—by the time you start to worry, it’s gone. “First, we’re looking for a correlation: Can we attribute the diarrhea to a recent meal or a sick family member?” says DiSandro. For more persistent cases of diarrhea where a healthcare provider doesn’t know what’s causing it, he or she will usually want to test blood and stool samples. They’ll be looking for blood in the stool, signs of organisms like bacteria or parasites, and sometimes fat, which would point to a malabsorption condition. Once your healthcare provider understands the cause, they’ll be better able to treat or manage the underlying condition.